LIVING WITH HIV

HIV/AIDS treatment

North County Connection is a program brought to you by Vista Community Clinic (VCC). VCC offers a full range of services to HIV-infected individuals in North San Diego County. Patient care is provided by caring, compassionate and committed staff, including specially trained physicians and counselors. VCC offers a continuum of care for clients HIV/AIDS related needs including:

T-cell/viral load testing
complete primary care
on-site dispensary
hospitalization at Tri-City Medical Center
AIDS Drug Assistance Program certification
treatment education
English/Spanish support groups
case management services

Want more information about receiving your HIV/AIDS care from Vista Community Clinic? Click here to contact us.

Ryan White Case Management

The Ryan White HIV/AIDS Program helps people with HIV/AIDS who have nowhere else to turn for the care they need. If you are HIV-positive, you can get medical care and other services even if you do not have health insurance or money to pay for health services and medications. Ryan White Program Medical Case Management is a comprehensive service delivery system designed to link individuals with needed care components. Improving client self-care, independence and self-determination are the primary goals of this program. Clients are involved in all aspects of their care, including problem-solving functions to the best of their abilities. Proactive, coordinated efforts by healthcare providers in community-based organizations will assist clients in obtaining optimum wellness, as well as making the best possible use of available resources. Attention to continuity of care will decrease service inaccessibility and fragmentation. The role of the HIV Medical Case Manager is multi-faceted. In addition to outreach and intake, the HIV Medical Case Manager is responsible for:

Assessing the individual’s need for services
Determining availability and feasibility of services
Developing a plan of care that includes home and community-based services appropriate to the individual’s medical, social, and financial condition
Arranging for service delivery
Monitoring service delivery
Maintaining confidentiality of client records within the service delivery system
Conducting ongoing evaluation of the effectiveness of the plan of care
Coordinating ongoing medical care with other services providers through case consultations

Am I eligible? To be eligible to receive health and dental care, medications, and other health-related services through the Ryan White HIV/AIDS Program, you must:

Be diagnosed with HIV or AIDS
Have an income too low to pay for care
Have no health insurance or not enough insurance to pay for the care you need

In some cases, your family members can receive services through a Ryan White Program focused on women, infants, children, and youth, even though they are not diagnosed with HIV. Interested in learning more from one of our Case Managers? Click here to contact us.

Your treatment regimen

Your treatment regimen can only be effective if you take your medications correctly and on time. This is called treatment adherence. It means you’re taking the correct dose of medications on time, every time, exactly as prescribed by your health care provider. This section will help you understand why adhering to your treatment regimen is so important. It covers some of the challenges you may face and offers some tips to help you face those challenges successfully.

The Importance of Adhering to Your Regimen

HIV is active from the moment it enters your body, seeking CD4 / T-cells cells to infect so it can reproduce.
A certain level of HIV medication must be present in the body to stop HIV replication and suppress viral load.
When medication levels are too low, the virus can replicate. If this happens, the virus can mutate and develop a resistance to one or more of your medications. Your medications will stop working properly and your future treatment options may become limited. If a medication-resistant HIV strain is transmitted to others, it will be harder for them to treat their infection. Studies show that a 95% or greater adherence rate is needed for its full benefit.
Being medically adherent from the beginning offers the best chance for long-term treatment success.

How to Ensure Proper Medication Adherence

Here is a checklist of questions to ask your doctor or pharmacist whenever a new medication is prescribed.

How many of each medication do I take at a time?
How many times a day do I take each medication and when?
Can I take HIV medications with other medications? Can I take them with supplements, over-the-counter-medication and herbal remedies?
Do I take my medications with food or on an empty stomach?
What if I forget or miss a dose?

Finding the Best Treatment Regimen

Your ability or willingness to take the medicine as prescribed is important when choosing a new medication regimen or deciding if the regimen you’re on is right for you. Discuss your preferences, habits and any adherence obstacles with your health care professional. Adherence problems should not make you feel ashamed. An open, honest discussion will help you avoid adherence challenges and help your health care providers put together the best treatment regimen for you. Here is a check list of issues to discuss when making treatment decisions with your doctor.

Are you a creature of habit or do you forget easily? Do you do many things at the same time daily or does your schedule vary from day to day? The answer will help determine when and how often you take your medications.
Do you eat on a regular schedule? Your answer can help determine the kind of food restrictions you can live with.
Do you have a problem swallowing pills? Your doctor may be able to prescribe fewer or smaller pills and tablets.
Are you taking other prescriptions, over-the-counter medications or supplements? Some medications cannot be taken together. Others may need different doses when they’re combined with other medications. Let your doctor and pharmacist know all the medications, over-the-counter medicines and supplements you’re taking.
Can you deal with potential side effects? If you can’t deal with side effects, talk to your doctor about modifying the prescription. Always keep in mind that non-adherence result in inadequate levels of medications in the blood, leading to unnecessary side effects, and virus replication.

Some Adherence Challenges

Mental Health
Stress
Substance use
Living conditions/Homelessness

If you are struggling with any one of these speak to your health care provider about how you can work together to develop a regimen that works for you.

Tips for Successful Adherence to Medications

Is there something you do automatically every day at the same time, like brush your teeth, make coffee or turn on the TV? Put your medications next to those objects.
Some clinics, service organizations and pharmacies offer free reminder programs that will call or text to remind you to take your medication. Ask your healthcare professional if this service is available in your area.
Your cell phone may include a program that will alert you at pre-set times.
Do you travel often? Be sure to carry your medication in your carry-on luggage and bring a couple days’ worth of extra doses in case of delays, cancellations or lost luggage.
To prevent serious medication interactions, it’s a good idea to bring all of your medications including prescriptions, over-the-counter, supplements and herbal remedies to your healthcare provider periodically for a complete review.
There are FREE one-week, two-week and one-month pill boxes that let you organize your medication ahead of time.
Some pharmacies will sort all of your daily medications and organize them into individual dosage packets instead of separate pill bottles. Ask if your pharmacy provides this service.
Look into portable pocket-sized pill cases with built-in alarm clocks. These are useful if you travel frequently or need to take your medication on the go.

For more questions on medication adherence contact us here.

HIV Medications

There are many types of medication for the treatment of HIV infection. For the most up to date information about specific mediations, please visit www.thebody.com or www.aidsmeds.com, under the category “Treatment.” Below you can find general information about the different types of HIV medication that are used to treat HIV. HIV Medication Facts

There are many HIV medications available that have been approved by the U.S. government.
No drug currently on the market can cure HIV infection.
No one drug alone can provide effective HIV treatment but there are one pill medications that are a combination of more than one drug that are effective in treating HIV.
When several medications are used in combination, they can effectively control HIV and maintain the health of your immune system. This combination is called ART or HAART. There are 5 classes of HIV medication in use today. All are designed to interfere with the ability of HIV to reproduce itself inside your body. Each class stops the virus at a different point in its reproductive cycle.

Protease Inhibitors (PI)

Protease inhibitors stop infected cells from reproducing the virus (blocking a protein called Protease which is necessary for production of infectious viral particles).

Nucleoside or Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

NRTIs block an enzyme needed by HIV to make copies of itself through a process called reverse transcription. HIV uses reverse transcriptase to convert RNA into DNA. DNA is the genetic structure that makes us who we are. Once the virus’s DNA has been integrated into the body’s natural DNA, HIV becomes a lifelong infection. The NRTIs stop the virus’s ability to create its DNA inside the nucleus of a healthy human cell. Because HIV cannot infect that cell, this breaks the viral DNA replication chain.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NNRTIs bind to and alter reverse transcriptase, an enzyme HIV needs to make copies of itself. The NNRTIs attach themselves directly to reverse transcriptase so that viral RNA cannot be converted into DNA, thus preventing further replication of the virus. Entry Inhibitors (includes Fusion Inhibitors) This class of drugs interferes with fusion and entry of the HIV virus into human CD4 cells (CD4 is a kind of cell that helps the body fight an infection). By blocking this step in HIV’s replication cycle, this drug can slow the progression from HIV infection to AIDS.

Integrase Inhibitors

This class of antiretroviral drugs is designed to block the viral enzyme, called Integrase, which is responsible for inserting the virus into the body’s DNA to make copies of itself.

New Drug Research

New drug classes are currently being developed and tested to create treatment variations for patients who have exhausted other options. Often, these new HIV treatment regimens use new combinations of drugs from different classes to simultaneously attack the HIV life cycle at different stages of development. For more information on the most current HIV drugs, please visit www.thebody.com or www.aidsmeds.com, under the category “Treatment.”

Sex And Sexuality

Sex can be a difficult thing to talk about, whether you’re HIV positive or negative. However, being HIV positive has its own unique set of challenges. Listed below are tips to help you deal with any negative feelings you might be experiencing. Talk to Your Sexual Partners

It’s important to discuss your HIV status with your sexual partners. Partner Services can help you disclose your status to your partners if you need help. For more information about Partner Services, please visit www.knowanddisclose.com.
Whether you are talking to your current partner, a former partner, or a potential new partner, here are some tips to prepare for the discussion:
Before having the discussion, decide on a good place and time, ideally where and when you will both be comfortable and able to talk openly.
Think about the person’s possible reactions. Write them down and think about how you want to respond.
If this person may react violently or in a self-destructive way, think about safety first, and plan to have the discussion in the presence of a case manager or counselor.

Talk to Your Primary Partner

If you’re in a relationship with a partner who is HIV negative, it’s important that they get tested regularly and that you both know your status.

Talk to New Partners

You may not know this person well or know how to gauge their reaction. Every situation will be different depending on the person.
You may favor a direct approach and simply inform your potential new partner that you have HIV. Or you may want to initiate a discussion about safer sex. However you approach it, informing potential partners of your status before you have sex is important.
In any event, practicing safer sex decreases the chance of the transmission of HIV and other STDs.

Talk to Former Partners

If you think you exposed a former sex partner or someone you share needles with, it’s important that they get tested. Talking to former partners can be difficult, if you need help visit www.knowanddisclose.com‎. There are options to notify past partners anonymously.

Protecting Yourself and Others

Safer sex means staying healthy while still enjoying sex, without transmitting, or acquiring STDs. It’s important to protect both you and your partner/s.

Ways to reduce risk

Use condoms. Condoms limit transmission of HIV. They also protect against other STDs and re-infection with new drug-resistant strains of HIV.
Make sure to take your medication. This significantly lowers HIV transmission risk if the infected partner is taking antiretroviral medications (be sure to take every dose of the medication on schedule).
Avoid sex when infected with an STD.
PrEP is an HIV prevention method for people who are HIV-negative. It involves taking a daily anti-HIV medication to reduce the risk of becoming infected with HIV.

Discuss Your Boundaries with Your Partner

For many people, having sex with others involves both an emotional commitment as well as a physical one. It is important, to be honest and open your statues.

Have open discussions about your desires, your fears, and your limits.
Agree on ways of sexual expression that fit with the level of risk you are comfortable with.
Talking to a sexual or relationship counselor can help.

For additional information: http://www.thebody.com/content/art55344.html

Partner Services

The County of San Diego offers Partner Services. This free and confidential service provides a safe way for HIV-positive people to tell their sexual or needle-sharing partners that they may have been exposed to HIV whether it was recently or for a length of time. One in five persons infected with HIV does not know they are HIV-positive and may unknowingly pass the virus on to his or her partner. Partner Services Health Advisors are highly trained public health professionals who help people understand their options for getting assistance to notify their partners. They can help anyone who is HIV-positive to choose the best disclosure assistance option for each situation. Once a partner has been told of his or her exposure to HIV, the Health Advisor provides resources and information to address any questions that might come up and can even provide HIV testing. Health Advisors understand that talking about HIV is not easy; they walk each person through the process at a comfortable pace without any judgment, protecting confidentiality throughout the process. This means that they will never reveal any information to any of the people who are notified. If you are HIV-positive and choose to talk with a Health Advisor, they can help you in one or more of the following ways:

Health Advisors use the information you provide to notify your partner for you without ever letting them know who you are. This Partner Service option is called third-party notification.
Health Advisors can be with you when you tell your partner to provide you with support and to answer any questions either of you may have. This Partner Services option is called dual disclosure assistance.
Some people feel they’re ready to tell their partner themselves, but may need a little support before they do it. Health Advisors can help you to plan how to tell your partner yourself. They can help you figure out what to say and how and when to say it. They can even give you information about testing and other services that you can share with your partner. This Partner Service option is called self-disclosure assistance.

Remember: Health Advisors can tell your partner(s) about their exposure to HIV without revealing any information about you – your name or any information about the times you were together. Whatever option you chose, a Health Advisor can offer free HIV testing to your partner(s). Interested in speaking to a Partner Services Health Advisor? Click here to contact us.